P257Predictors of clinical usefulness of pocket-sized ultrasound in a general medical department


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Abstract

Purpose: By performing a cardiovascular and an abdominal screening by pocket-sized ultrasound lasting less than 10 minutes we changed, verified or added important diagnosis in 47 % of patients admitted to a general medical department. The aim of this study was to evaluate predictors of usefulness with respect to diagnostic adjustments.Methods: Patients admitted to a non-university hospital in Norway in the period from March 1st 2010 to September 30th 2010 were screened with pocket-sized ultrasound with b-mode and color flow imaging (size of unit: 135x73x28 mm). After a principal diagnosis was set in the emergency room, the patients underwent cardiac and abdominal ultrasound screening performed by one of three performing physicians, all cardiologists with some experience in abdominal ultrasound. The usefulness of the screening was classified as 1) change of principal diagnosis, 2) verification of principal diagnosis, 3) additional diagnosis made and 4) no diagnostic change. All patients were categorized by the Study Committee. Diagnostic influence was classified as any of the first three.Results: 196 patients were included (male=57%, 68.1±15.0 years old). The Odds ratio (OR) for any diagnostic usefulnesswas 1.6, 95% CI (1.3-2.0), (p<0.001) per 10 years higher age and 2.0, 95% CI(1.7-2.3), (p 0.02) for those with known cardiovascular disease (CD). In the group of patients with either known CD or increased risk of CD (hypertension, diabetes mellitus) the OR was 2.9, 95%CI (2.6-3.2), (p<0.001). Looking only at the patients having their primary diagnosis changed the OR was 1.6, 95% CI (1.4-1.9), (p 0,003) per 10 years higher age and 1.2, 95% CI (0.8-1.6), (p 0.63) for those with known CD. In the group of patients with either known CD or increased risk the OR was 3.0, 95% CI (2.5-3.4), (p 0.02).Conclusions: Age, known CD or increased risk of CD are predictors for clinical usefulness of a bedside screening with pocket-sizedultrasound in patients admitted to a medical department.

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